I Deserve a Friggin' Oscar

The field training program wasn’t especially easy for me.  I didn’t have an especially hard time meeting expectations, but the Denver Paramedics was pretty different from the agency in which I began my EMS career.  I started in a private service that transported for an ALS fire department.  So I was skilled at quietly affecting a call without taking it over: “How do you guys feel about an amp of D50 before Fred intubates him?”

When I went to Denver Health, I discovered the joys of a pure ALS service with a BLS fire department.  One of my two biggest problems that the field training program beat out of me was the ability to be in charge of everything on the scene.*  I recall one of my first calls; we arrived to a dyspneic patient who was tripoding and two or three word dyspneic.  The BLS crew was on scene, but oxygen hadn’t yet been applied: “How do you guys feel about giving him some oxygen?”  The firefighters looked at me with very uncomfortable expressions - this was a situation that they weren't used to.  Someone asking them what to do?!?  What I should have done is taken charge of the scene: “I need him on a non-rebreather. Get my wheels, please, and set me up for a line and a 12-lead.”

The transition from “How do you feel about…” to “I need…” was a hard one for me to make, believe it or not.  There I was, 25 years old and a little more than a year out of paramedic school, expected to be in charge of a whole team of public safety providers.  In my head, I knew that I was an idiot who knew next to nothing.  The other people on scene had been doing this for decades in some cases.  Some were as old as my father!  (And try ordering him around, I dare you…)  I rarely had a firm grasp on what was going on.  I shouldn’t have been in charge of my own checkbook, let alone a cardiac arrest or a multiple vehicle car crash.  Didn’t everyone know that I was grossly incompetent?!?

I found success by acting.  Pure method acting.  Faking it.  Completely fraudulent affectations.

By Amaranthe26 via Wikimedia Commons, with permission and modified.

Now for the really embarrassing admission: I would talk to myself in the side view mirror on the way to calls.  “Who’s in charge? You!  You got this, Bill!  You can handle it!  Nobody will doubt who is making decisions!  Hooah!”  Like the daily affirmations of Al Franken’s Stuart Smalley, or something.

I had to make a conscious and continuous effort to act like a paramedic.  I didn't feel like a paramedic.  I made the effort to act like I knew what was going on.  I didn’t feel like I knew anything.  I made an effort to act like I could handle whatever I found on the call.  I certainly didn’t feel that way.

Nobody knew it was an act.  I doubt they would have cared, because the job was getting done.

As time passed, I became more skilled as a paramedic.  Sure, I worked at increasing my didactic knowledge base.  Experience helped immensely; there is no substitute to running thousands of calls.  Nowadays, it is a rare call that offers something that I haven’t seen before.  I have made mistakes and learned from them.  I obsess over my shortcomings and try to fix them.  So the need for acting has decreased, but it has never gone away.  I don’t think it ever will.  I have come to the realization that a large percentage of prehospital medicine is pure acting.

I act like I am interested in the patient’s mild nausea symptom.  
I act like I am interested in what kicked off the patient’s anxiety attack.  
I act like the patient has my full attention.  
I act like I am not hangry.  
I act like the patient shouldn't be embarrassed about what is currently stuck in his rectum.  
I act like I have heard of the patient’s weird disease and then secretly look it up behind them in the ambulance.  
I act like I remember the patient’s name, but am only asking again because I want to make sure of how it is spelled.  
I act like chronic fatigue syndrome isn't really a psychiatric issue.
I act like it matters to me that the patient doesn’t refuse transport.  
I act like I got enough sleep last night.  
I act like this call won't emotionally scar me and give me nightmares in the future.  
I act like my back doesn’t hurt.  
I act like the story my partner is telling me is a good one.  
I act like I care about what the receiving nurse thinks the patient being transported to her hospital.  
I act like I am calm when I am on the radio.  
I act like I’m not hungover.  
I act like I’m more than happy for the biophone physician to talk to the patient (on my cellphone).  
I act like other people call 911 for similar problems all the time.  
I act like my mood is a positive one.

Don’t misunderstand me.  My concern for a patient isn’t an act on every call.  Neither is my interest in my partner, for the most part.  My confidence isn’t an act all of the time, or even most of the time.  But all of us have off days, irritating patients, irritating partners, empty bellies, occasional hangovers, bad weather, our own health problems, off-duty relationship issues, and other distractors.  All of us can be confronted with a call that makes us feel overwhelmed and incompetent.  The patient, their family, and other agencies and providers don’t especially care (if they say they do, it is likely an act on their part).  We have a job to do.  If acting advances the call more than the truth does, act.  You may be surprised at how acting a way results in it becoming true.

My acting continues to this day.  You know you’re a pretty skilled medic when people rarely know you’re acting.

*The other challenge was alternative call dispositions.  An ambulance service isn’t really paid for refusals.  So transports are important to the financial viability of a private company, where as a third service (or hospital based pseudo-third service) has other concerns along with finances.  Concerns like keeping ambulances in service.  So dispositions are relatively much less important in the privates, at least 15 years ago, so it was a skill that I didn’t have enough practice to be good at.